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RC1 83  .M58  1 889   Prevention  and  restr 


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Michigan.  Dept.  of  health. 
Prevention  and  restriction  of 
Small-Pox,  1389. 


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mtijeCitpoflfattigmrk 

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PREVENTION  AND  RESTRICTION  OF 
SMALL-POX. 


DOCUMENT  ISSUED  BY  THE  MICHIGAN  STATE  BOARD  OF 

HEALTH. 

(Revised  Edition  of  1889.— 10,000  copies  reprinted  from  the  Annnal  Report  of  the  Board  for  1888.) 

[Reprint  No,  291.] 


PREVENTION    OF    SMALL-POX. 

1.  Small-pox  a  preventable  disease. — It  has  long  been  known  that  small-pox 
can  be  prevented  or  modified  by  vaccination.  It  is  now  believed  that  a  wide- 
spread epidemic  of  the  disease  can  be  attributed  only  to  an  equally  wide- 
spread ignorance  or  willfulness  concerning  small-pox  and  its  prevention  by 
vaccination. 

2.  Why  vaccinate  — Because  unmodified  small-pox  is  so  deadly  a  disease, 
and  so  often  disfigures  and  enfeebles  those  who  recover,*  and  because  by  trav- 
eling or  by  travelers,  by  articles  received  in  the  mail  or  from  stores  or  shops, 
or  in  various  other  ways  any  one  at  any  time  may  without  knowing  it  be 
exposed  to  small-pox,  it  becomes  important  so  far  as  possible  without  injury 
to  health  to  render  every  person  incapable  of  taking  the  disease.  This  may 
be  done  so  perfectly  by  vaccination  and  revaccination  with  genuine  bovine 
vaccine  virus  that  no  question  of  ordinary  expense  or  trouble  should  be 
allowed  for  a  day  to  prevent  the  careful  vaccination  of  every  man,  woman 
and  child  in  Michigan,  and  the  revaccination  of  every  one  who  has  not  been 
vaccinated  within  five  years.  It  is  well  established  that  those  who  have  been 
properly  vaccinated  are  far  less  likely  to  take  small-pox  if  exposed  to  it,  and 
that  the  very  few  who  have  been  properly  vaccinated  and  have  small-pox 
have  it  in  a  much  milder  form  and  are  much  less  disfigured  by  it  than  those 
who  have  not  been  thus  vaccinated.  The  value  of  vaccination  is  illustrated 
by  the  following  facts: — 

On  March  13,  1859,  Dr.  E.  M.  Snow,  of  Providence,  R.  I.,  found,  in  a 
cluster  of  seven  houses,  twenty-five  families,  and  in  these  families  ten  cases 
of  small-pox,  all  apparently  at  about  the  same  stage  of  the  disease.  In  the 
same  families  there  were  twenty-one  children  who  had  never  been  vaccinated. 
The  ten  cases  and  the  remaining  members  of  the  families  including  the 
twenty-one  children  were  quarantined  at  home,  and  the  children  were  all 
vaccinated  and  compelled  to  remain  with  the  sick.  Several  other  cases  of 
small-pox  occurred  in  persons  previously  exposed,  but  not  one  of  the  twenty- 
one  children  referred  to  had  the  slightest  touch  of  the  disease. 

♦■'Among  those  who  outlive  it,  many  either  totally  or  partially  lose  their  sight  or  hearing;  many 
are  left  consumptive,  weakly,  sickly,  or  maimed,  many  are  disfigured  for  life  hy  horrid  scars,  and 
become  shocking  objects  to  those  who  approach  them.  Immense  numbers  lose  their  eyesight  by 
it."— La  Condamine. 


2  PREVENTION  OF  SMALL-POX. 

In  Sweden  the  average  number  of  deaths  in  each  year  from  small-pox  per 
one  million  inhabitants  was, — 

Before  the  introduction  of  vaccination  (1774-1801),  1,973; 

During  the  period  of  optional  vaccination  (1802-1816),  479; 

And  during  the  period  of  obligatory  vaccination  (1817-1877),  189. 

Vaccination  was  introduced  in  England  near  the  beginning  of  the  present 
century,  and  since  1853  compulsory  vaccination  has  been  attempted.  In 
England  the  number  of  deaths  in  each  year  from  small-pox  per  one  million 
inhabitants  was, — 

At  the  close  of  the  last  century,  3,000; 

From  1841  to  1853  (average),  304; 

From  1854  to  1863  (average),  171. 

In  the  Bavarian  army  revaccination  has  been  compulsory  since  1843.  From 
that  date  till  1857,  not  even  a  single  case  of  unmodified  small-pox  occurred, 
nor  a  single  death  from  small-pox. 

During  42  years  of  duty,  Dr.  Mar3on,  physician  of  the  London  small-pox 
hospital,  has  never  observed  a  single  case  of  small-pox  in  the  officers  and 
employees  of  the  hospital,  who  are  revaccinated  when  they  enter  the  service, 
and  who  are  constantly  exposed  to  the  infection. 

"Out  of  more  than  10,000  children  vaccinated  at  Brussels  with  animal 
lymph,  from  1865  to  1870,  and  who  went  through  the  terrible  epidemic  of- 
small-pox  which  in  1870  and  1871  frightened  the  world,  not  a  single  one  was, 
to  my  knowledge,  reported  as  being  attacked  by  the  disease.  The  same 
immunity  was  shared  by  those — a  much  larger  number — whom  I  had  revacci- 
nated, and  who  at  the  same  time  were  living  in  epidemic  centers." — Dr. 
Warlemont,  of  Brussels. — [North  Carolina  Medical  Journal,  January,  1880. 
Vol.  v.,  p.  2.] 

3.  Who  should  be  vaccinated. — Everybody,  old  and  young,  for  his  own 
interest  and  that  he  may  not  become  a  breeding-place  for  the  distribution  of 
small-pox  to  others,  should  seek  that  protection  from  small-pox  which  is 
afforded  by  vaccination  alone.  It  is  believed  that  all  persons  except  those 
mentioned  in  the  following  paragraph  may,  if  the  operation  is  properly  per- 
formed, at  the  proper  time,  and  with  pure  bovine  virus,  be  vaccinated  with 
perfect  safety  to  themselves.  Even  those  who  have  had  small-pox  should 
be  vaccinated,  for  otherwise  they  may  take  the  disease;  and  it  seems  to  be 
proved  that  a  larger  proportion  of  those  who  have  small-pox  a  second  time 
die  than  of  those  who  have  the  disease  after  vaccination. 

4.  Who  should  not  be  vaccinated. — Unless  exposure  to  small-pox  is  believed 
to  have  taken  place,  or  likely  to  take  place,  teething  children,  pregnant 
women,  persons  suffering  with  measles,  scarlet  fever,  erysipelas,  or  suscep- 
tible to  and  recently  exposed  to  one  of  these  diseases,  persons  suffering  with 
skin  disease  or  eruption,  and  in  general  feeble  persons  not  in  good  health, 
should  not  be  vaccinated.  In  all  cases  in  which  there  is  any  doubt  as  to  the 
propriety  of  vaccinating  or  postponing  vaccination,  the  judgment  of  a  good 
physician  should  be  taken.  The  restriction  as  to  vaccinating  teething 
children  makes  it  important  that  children  should  be  vaccinated  before  the 
teething  process  has  begun,  because  small-pox  is  very  much  more  dangerous 
than  vaccination.     Small-pox  is  exceedingly  dangerous  to  pregnant  women. 

5.  When  should  a  person  be  vaccinated. — The  sooner  the  better  as  a  rule,  and 
especially  whenever  there  is  much  liability  of  exposure  to  small-pox.  Children 
should  be  vaccinated  before  they  are  four  months  old ;  those  who  have  never 


WHAT  VACCINE  VIRUS  SHOULD  BE  USED.  3 

been  vaccinated,  should,  with  the  exceptions  previously  made  in  paragraph  4, 
be  vaccinated  at  once.  Because  the  vaccination  often  loses  its  protective 
power  after  a  time,  those  who  have  been  vaccinated  but  once  or  twice  should, 
in  order  to  test  and  to  increase  the  protective  power  of  the  former  vaccina- 
tion, be  vaccinated  again  and  as  often  as  the  vaccination  can  be  made  to 
work.  For  the  first  three  or  four  scars  the  protection  afforded  is  believed  to 
be  somewhat  in  proportion  to  the  number  of  good  scars,  conditioned  always 
that  the  scars  be  the  result  of  a  proper  vaccination  with  genuine  vaccine 
virus.  In  general,  to  insure  full  protection  from  small-pox,  one  should  be 
vaccinated  as  often  as  every  five  years.  It  has  been  found  that  of  those  who 
have  small-pox  the  proportion  of  deaths  is  very  much  less  among  those  who 
have  three  or  four  good  vaccination  scars  than  among  those  who  have  but 
one  scar. 

Vaccination  as  late  as  the  second  day  after  known  exposure  to  small-pox 
i6  believed  to  have  prevented  the  small-pox ;  vaccination  the  third  day  after 
exposure  has  rendered  the  disease  much  milder  than  usual,  and,  in  a  case  in 
Iowa,  vaccination  on  the  seventh  or  eighth  day  after  exposure  to  small-pox 
ran  a  partial  course  and  was  believed  to  have  modified  the  attack  of  small- 
pox, which,  however,  it  did  not  wholly  prevent. 

6.  With  what  should  one  be  vaccinated — Virus  taken  from  the  arm  of  one 
vaccinated  a  second  time  is  worthless  because  unreliable.  Virus  dissolved 
and  carried  about  between  glass  slips  in  the  pocket  of  the  vaccinator  is  liable  to 
contamination  and  fermentation ;  bovine  virus  dried  on  ivory  or  quill  points 
is  preferable.  It  should  be  remembered  that  a  spurious  vaccination  which 
does  not  produce  a  vaccine  vesicle,  while  it  affords  no  protection  against 
smali-pox,  may  prevent  subsequent  vaccination  which  shall  be  protective. 
For  this  reason  it  is  important  to  use  only  virus  from  reliable  sources  and 
free  from  contamination  or  decomposition.  In  a  majority  of  cases,  if  the 
virus  be  taken  at  the  proper  time  (eighth  day  after  vaccination)  from  the  arm 
of  a  healthy  child  having  no  taint  of  a  hereditary  or  communicable  disease, 
such  as  scrofula,  consumption,  syphilis,  erysipelas,  scarlet  fever,  etc.,  and 
undergoing  the  action  of  its  first  vaccination,  and  if  a  properly  clean  lancet 
be  used,  no  harm  will  result  to  the  person  vaccinated,  and  a  good  vaccination 
may  be  secured.  This  method  involves  rupturing  the  vesicle  on  the  arm  of 
the  child  from  whom  the  virus  is  obtained,  and  this  is  objectionable  because 
it  may  interfere  with  the  complete  development  of  its  vaccination.  But 
because  harm  has  sometimes  resulted  from  the  use  of  virus  taken  from 
another  person,  because  it  is  often  impossible  to  tell  whether  a  child  has  pure 
blood  and  is  free  from  every  disease,  because  it  is  so  easy  to  obtain  pure  and 
fresh  bovine  virus,  and  because  such  bovine  virus  is  efficient,  it  is  better  in 
all  cases  to  use  only  the  pure  and  fresh  bovine  virus. 

Eeasons  for  preferring  bovine  virus  to  humanized  virus  may  be  given  as 
follows: — (1.)  By  the  use  of  the  bovine  virus  there  is  secured  a  more  perfect 
or  typical  development  of  the  vaccine  disease ;  and  hence  it  may  fairly  be 
inferred  a  greater  protection  against  small-pox.  (2.)  With  the  bovine  virus 
and  with  a  clean  lancet,  and  with  clean  surroundings,  there  is  no  danger  of 
communicating  syphilis.  (3. )  The  bovine  virus  is  far  more  effective  than 
the  humanized  virus  in  revaccination  ;  and  where  the  humanized  virus  fails 
and  the  bovine  virus  works  it  is  probable  that  there  was  susceptibility  to 
small-pox  which  the  humanized  virus  did  not  remove  but  which  has  been 
removed  by  the  bovine  virus.     (4.)  Greater  care  can  be  taken  in  the  propa- 


4  VACCINE  VIRUS  AND  VACCINATION. 

gation  of  bovine  virus,  a  greater  supply  can  be  always  at  command,  and 
always,  but  especially  in  times  of  urgent  danger  from  small-pox  people  can 
have  a  better  guarantee  that  they  are  vaccinated  with  genuine  and  pure  vac- 
cine virus. 

7.  Where  to  obtain  fresh  and  pure  bovine  virus. — Dr.  E.  L.  Griffin,  of  Fond 
du  Lac,  Wis.,  by  a  series  of  inoculations  of  young  heifers  propagates  virus 
of  the  Belgian  stock  of  cow-pox,  obtained  from  Dr.  Warlomont,  director  of 
the  government  vaccine  establishment  of  Brussels.  This  virus,  so  far  as 
known,  never  has  passed  through  the  human  subject.  It  is  stored  on  ivory 
points,  each  of  which  holds  enough  virus  to  vaccinate  one  person,  and  should 
be  used  only  for  one  person.  Ten  points  are  sent  by  mail  for  one  dollar ; 
and  if  used  according  to  the  directions  of  Griffin's  circular  within  five  days 
of  the  receipt  of  the  package  their  efficiency  is  guaranteed  by  him.  Dr, 
Henry  A.  Martin  and  son,  Eoxbury  Station,  Boston,  Mass.,  propagate  virus 
of  the  Beaugency  stock.  Dr.  Martin  claimed  the  honor  of  being  the  first 
propagator  of  bo-vine  virus  in  the  United  States.  Both  Dr.  Griffin  and  Dr. 
Martin  are  believed  to  be  reliable  propagators  of  bovine  vaccine  virus.  Virus 
is  for  sale  by  most  druggists.  The  State  Board  of  Health  does  jiot  supply 
vaccine  virus. 

8.  Where  should  vaccination  be  performed. — In  a  room  or  place  free  from 
persons  suffering  from  disease,  and  from  dust  or  vapors  which  may  convey 
to  the  scratched  surface  germs  of  any  communicable  disease ;  certainly  not  in 
or  near  a  room  where  there  is  erysipelas,  nor  in  the  presence  of  one  who  has 
just  come  from  a  person  sick  with  erysipelas,  diphtheria,  or  scarlet  fever. 

9.  By  whom  should  one  be  vaccinated. — The  operation  of  vaccination  should 
be  performed  always  by  a  competent  and  responsible  physician,  or  by  some 
one  whom  he  has  instructed  and  recommends  to  perform  the  operation.  To 
iry  to  vaccinate  one's  self  or  one's  family  is  poor  economy,  for  ifc  often  results 
not  only  in  a  waste  of  money  and  of  time  but  in  a  false  and  dangerous  feel- 
ing of  security.  To  trust  to  vaccination  by  nurses  and  midwifes  is  equally 
foolish.  A  well-educated  and  experienced  physician  has  the  skill,  and.  the 
special  knowledge  necessary  to  the  best  judgment  on  all  of  the  questions 
involved,  without  which  the  operation  may  be  a  failure  or  worse  than  a  fail- 
ure.    In  work  of  this  kind  the  best  is  the  cheapest,  whatever  it  costs. 

10.  How  to  vaccinate. — In  remote  places  it  is  sometimes  necessary  to  vac- 
cinate persons  who  are  practically  beyond  the  reach  of  a  competent  phy- 
sician. For  the  benefit  of  such,  and  not  as  an  encouragement  to  others  to 
dispense  with  the  services  of  a  skillful  physician,  the  following  suggestions 
are  made  as  to  the  best  method  of  vaccinating.  As  a  rule  the  most  conven- 
ient place  for  vaccination  is  found  to  be  on  the  outer  surface  of  the  left  arm, 
about  one-half  or  two-thirds  the  way  up  from  the  elbow  to  the  shoulder.  An 
infant  which  its  mother  carries  on  her  right  arm  should  be  vaccinated  on  its 
right  arm  in  order  to  avoid  rupturing  the  vesicle  by  pressure  against  its 
mother.  With  a  sharp  pointed  and  perfectly  clean  instrument  (lancet)  make 
six  parallel  scratches,  barely  sufficient  to  make  a  show  of  blood,  but  not  to 
cause  bleeding.  Directly  across  these  scratches  make  four  or  five  similar 
scratches,  so  that  the  scarified  place  shall  be  as  large  as  a  split  pea,  and 
something  like  this  illustration:  If  blood  flows,  wait,  and  wipe  it  off  (jj-j 
before  applying  the  lymph.    The  virus  is  at  and  near  the  pointed  end  of 

the  ivory  carrier.  Moisten  the  lymph  upon  the  ivory  point  with  half  a  drop  of 
pure  water,  which  has  recently  been  boiled  and  cooled,  smeared  over  it  with 


COMMON  APPEAEANCES  AFTER  VACCINATION.  5 

the  lancet.  Then  rub  the  point  over  the  scarified  surface  briskly  for  a  minute  so 
as  to  lodge  the  granules  in  the  abraded  surface.  The  lymph  which  may  be 
deposited  on  the  sound  skin  should  be  scraped  upon  the  scarified  place  and 
allowed  to  dry  there.  When  the  arm  is  dry  return  its  ordinary  clothing, 
between  which  and  the  arm  a  loose,  soft  cloth  should  be  fastened.  Do  not 
put  on  a  tight  bandage  or  any  plaster.  Let  no  saliva  touch  the  scratched 
place,  neither  to  affix  a  plaster  nor  in  any  way.  Allow  no  water  to  touch  the 
place  unless  it  has  been  recently  boiled.  When  an  ivory  point  has  been  used 
throw  it  in  the  fire.  Except  there  is  urgent  necessity,  do  not  use  the  same 
point  on  two  persons,  and  not  then  if  there  is  danger  of  communicating 
disease.  Vaccination  sometimes  fails  because  the  arm  is  not  well  scarified 
and  the  virus  is  not  thoroughly  rubbed  into  the  scarified  surface.  A  skillful 
vaccinator  can  generally  use  sufficient  care  to  insure  success  in  a  susceptible 
person.  Never  cut  entirely  through  the  skin.  Virus  should  not  be  inserted 
under  the  skin.  Except  with  young  children,  and  with  feeble  persons,  for 
whom  only  one  place  is  recommended,  two  or  more  places  an  inch  or  more 
apart  may  be  scarified  and  vaccinated. 

11.  After  vaccination. — Let  the  vaccinated  place  alone.  Do  not  scratch  it 
or  otherwise  transfer  the  virus  where  it  is  not  wanted. 

12.  Common  appearances  after  vaccination. — For  a  day  or  two  nothing  unusual 
should  appear.  A  few  days  after  that,  if  it  succeeds  regularly,  the  skin  will 
become  red,  then  a  pimple  will  form,  and  on  the  pimple  a  little  vesicle  or 
blister  which  may  be  plainly  seen  on  the  fifth  or  sixth  day.  On  the  eighth 
day  the  blister  (vesicle)  is,  or  should  be,  plump,  round,  translucent,  pearly 
white,  with  a  clearly  marked  edge  and  a  depression  in  the  center;  the  skin 
around  it  for  about  half  an  inch  is  red  and  swollen.  This  vesicle  and  the  red 
inflamed  circle  about  it  (called  the  areola)  are  the  two  points  which  prove 
the  vaccination  to  be  successful.  A  rash,  and  even  a  vesicular  eruption, 
sometimes  comes  on  the  child's  body  about  the  eighth  day,  and  lasts  about  a 
week;  he  may  be  feverish,  or  may  remain  quite  well.  The  arm  may  be  red 
and  swollen  down  as  far  as  the  elbow,  and  in  the  adult  there  will  usually  be  a 
tender  or  swollen  gland  in  the  armpit,  and  some  disturbance  of  sleep  for 
several  nights.  The  vesicle  dries  up  in  a  few  days  more,  and  a  crust  forms 
which  becomes  of  a  brownish  mahogany  color,  and  falls  off  from  the  twentieth 
to  the  twenty-fifth  day.  In  some  cases  the  several  appearances  described 
above  may  be  delayed  a  day  or  two.  The  crust  or  scab  will  leave  a  well- 
marked,  permanent  scar. 

13.  Signs  of  successful  revaccination. —  When  a  person  who  has  been  once  suc- 
cessfully vaccinated  is  afterwards  revaccinated  there  sometimes  results  a 
vesicle  which,  as  regards  its  course  and  that  of  the  attendant  areola,  cannot 
be  distinguished  from  the  perfect  results  of  a  primary  vaccination,  and  this 
is  more  likely  to  occur  if  bovine  virus  is  used.  But  often  the  result  is  modi- 
fied by  the  influence  of  the  previous  vaccination,  no  true  vesicle  forms,  but 
merely  a  papular  elevation  surrounded  by  an  areola ;  and  this  result  having 
attained  its  maximum  on  or  before  the  fifth  day,  afterwards  quickly  declines. 
Or,  if  a  vesicle  forms,  its  shape  is  apt  to  vary  from  that  of  the  regular  vesicle, 
and  its  course  to  be  more  rapid,  so  that  its  maturity  is  reached  on  or  before 
the  sixth  day,  its  areola  declines  on  or  before  the  eighth  day,  and  the  scab- 
bing begins  correspondingly  early.  In  either  case  the  areola  tends  to  diffuse 
itself  more  widely  and  less  regularly,  and  with  more  affection  of  the  areolar 
tissue  than  in  primary  vaccination,  while  the  itching  and  feverishness  may 


6  WHAT  TO  DO  AFTER  VACCINATION. 

be  present  much  the  same  as  in  primary  vaccination.  When  the  results  of 
a  re  vaccination  are  not  well  marked,  protection  should  not  be  presumed 
unless  the  same  virus  is  proved  to  be  efficient  in  a  primary  vaccination. 

14.  What  to  do  during  and  after  vaccination  — Do  nothing  to  irritate  the 
eruption,  do  not  pull  the  scab  off,  when  it  drops  off  throw  it  in  the  fire. 
When  the  eruption  is  at  its  bight  sbow  it  to  the  doctor  who  performed  the 
vaccination.  If  it  is  satisfactory,  ask  him  for  a  certificate  stating  when  and 
by  whom  you  were  vaccinated,  whether  with  bovine  or  humanized  lymph,  in 
how  many  places  and  with  what  result  at  each  place.  When  the  arm  is 
healed,  if  the  vaccination  did  not  work  well,  be  vaccinated  again  as  soon  as 
possible,  and  in  the  best  manner  possible.  This  will  be  a  test  of  the  protec- 
tion secured  by  the  former  vaccination,  and  will  itself  afford  increased  pro- 
tection. Do  not  be  satisfied  with  less  than  four  genuine  vaccine  scars,  or 
with  four  if  it  is  possible  to  secure  more  than  four.  This  vaccination  a 
second  or  third  time  in  close  succession  is  believed  to  be  hardly  less  import- 
ant than  vaccination  the  first  time,  and  hardly  less  valuable  as  a  protection 
against  small-pox.  Without  doubt  many  persons  are  living  in  a  false  sense 
of  security  from  small-pox  because  at  some  time  in  their  lives  they  have  had 
a  little  sore  on  their  arms  caused  by  a  supposed  or  a  real  vaccination,  or 
because  an  imperfect  vaccination  failed  to  "work,"  or  because  they  were  suc- 
cessfully vaccinated,  or  had  the  varioloid,  or  the  unmodified  small-pox  many 
years  ago.  Until  small-pox  is  stamped  out  throughout  the  world  so  that 
exposure  to  the  disease  shall  be  practically  impossible,  the  only  personal 
safety  is  in  such  perfect  and  frequent  vaccination  that  one  need  not  fear  an 
exposure  to  small-pox  through  the  recklessness  of  the  foolish.  Statistics 
abundantly  prove  that  among  the  unvaccinated,  small-pox  has  lost  none  of 
the  deadly  power  which  made  it  such  a  terror  to  former  generations. 

15.  Make  a  record  of  your  vaccination. — Do  not  fail  to  procure  and.  preserve 
the  certificate  mentioned  in  the  preceding  paragraph,  and  also  to  make  a 
personal  record  of  the  facts  with  regard  to  any  vaccination  of  yourself  or  in 
your  family.  From  it  you  may  sometime  learn  that  it  is  ten  years  since  you 
or  some  member  of  your  family  was  vaccinated,  when  you  thought  it  only 
five. 

16.  Vaccination  bafore  admission  to  the  schools.— In  some  places,  and  with 
good  results,  the  board  of  education  has  made  the  possession  of  a  certificate 
signed  by  some  competent  physician,  stating  that  the  child  has  been  success- 
fully vaccinated  within  a  given  number  of  years  or  months,  a  condition  to 
admission  to  the  public  schools.  Such  a  regulation  seems  to  be  one  of  the 
most  efficient  means  of  securing  a  general  vaccination  of  the  young  people. 

1?.  Corporations  and  large  business  firms  may  well  prevent  interruption  of 
their  business  by  small- pox  by  requiring  employees  to  exhibit  certificates  of 
successful  vaccination,  and  of  revaccination. 

18.  Do  not  delay  to  be  vaccinated. — By  setting  about  it  at  once  there  will  be 
time  to  secure  pure  and  fresh  vaccine  virus,  and  neither  sickness  nor  haste 
need  prevent  a  successful  vaccination.  But  if  one  puts  it  off,  he  may  sud- 
denly be  called  away  on  an  unexpected  journey  in  which  he  may  incur 
greater  risk  of  exposure  to  small-pox,  or  small-pox  may  appear  in  his  vicinity 
and  for  want  of  time  to  procure  reliable  vaccine  virus  he  may  be  compelled 
to  accept  vaccination  with  virus  neither  fresh  and  active  nor  of  known 
purity;  and  vaccination  with  inferior  virus,  while  it  affords  but  little  protec- 
tion against  small-pox,  may  be  a  hindrance  to  successful  vaccination  with 


RESTRICTION  OF  SMALL-POX.— NOTICE  TO  THE  BOARD  OF  HEALTH.       ? 

the  best  virus;  or  by  his  delay  he  may  contract  small-pox  itself,  with  all  its 
dangers  and  with  an  expense  many  times  larger  than  the  cost  of  thorough 
vaccination. 

19.  Small-pox  occurs  at  all  seasons  of  the  year,  but  as  a  rule  is  most  preva- 
lent in  cold  weather.  It  has  been  suggested  that  this  may  be  in  part  due  to  a 
lack  of  ventilation  in  winter,  by  which  the  poison  becomes  more  concentrated, 
and  to  the  greater  irritation  and  rawness  of  the  throat  and  air-passages 
caused  by  the  cold,  dry  air  and  by  the  more  abundant  ozone  in  winter,  the 
sore  throat  supplying  a  place  where  small-pox  may  easily  be  inoculated ;  it  is 
known  also  that  in  a  warm,  moist  air  vaccine  virus  decomposes  more  readily 
than  in  a  cold,  dry  air,  and  the  same  is  probably  true  of  small-pox  virus. 
This  greater  liability  to  small-pox  in  winter  makes  it  important  that  one 
should  not  wait  till  winter  and  its  dangers  have  come  before  being  vac- 
cinated, and  also  that  he  should  not  suffer  the  winter  to  pass  without  being 
vaccinated. 

20.  Small-pox  not  spontaneously  generated. — It  is  believed  that  neither  small- 
pox nor  any  other  strictly  contagious  disease  is  originated  in  Michigan,  and 
that  small-pox  may  in  great  part  be  kept  out  of  the  State  if  proper  measures 
are  taken,  such  as  the  systematic  inspection  of  immigrants  and  travelers  and 
the  isolation  and  disinfection  of  all  infected  material! 

21.  Premises. — Privies,  cesspools,  waterclosets,  drains,  gutters,  and  all  other 
such  places  liable  to  receive  the  contagium  of  a  disease  should  be  frequently 
and  liberally  treated  with  the  copperas  solution  mentioned  in  paragraph  9, 
on  a  page  preceding  this. 

22.  Rags  — No  person  should  handle  old  clothing  or  rags  without  taking 
precautions  to  prevent  the  spread  of  communicable  diseases.  Children  should 
not  be  allowed  to  go  near  a  rag-gatherer's  collection,  nor  into  the  rag-rooms 
in  paper-mills  or  store-house. 

EESTEICTION"    OF    SMALL-POX. 

When  small-pox  appears  in  a  place  it  is  generally  possible  to  restrict  it  to 
the  first  case  or  set  of  cases.  Five  things  (specified  in  paragraphs  numbered 
23,  24,  25,  26  and  27)  should  immediately  be  done,  and  several  other  things 
should  without  fail  be  done  in  their  proper  order,  somewhat  as  follows  : 

23.  Notice  to  the  local  board  of  health. — The  householder  within  whose  family 
a  case  of  small-pox  occurs,  and  the  physician  called  to  treat  a  case  of  small- 
pox should  at  once  give  notice  thereof  to  the  health  officer  (or  to  the  local 
board  of  health),  as  required  in  townships  by  section  1734  and  1735  of  the 
compiled  laws  of  1871  (§§1675  and  1676  Howell's  Statutes),  and  in  cities  and 
villages  by  section  1740  of  the  compiled  laws  of  1871,  as  amended  in  1879 
(§1681  Howell's  Statutes),  printed  in  paragraph  56,  on  a  following  page. 

Section  1734  and  1735,  C.  L.  1871  (§§1675  and  1676,  Howell's  Statutes),  as 
amended  by  Act  11,  Laws  of  1883,  and.  the  section  (50)  added  in  1883,  are  as 
follows: 

(1734).  Sec.  43.  Whenever  any  householder,  hotelkeeper,  keeper  of  a  boarding  house 
or  tenant  shall  know,  or  shall  be  informed  by  a  physician,  or  shall  have  reason  to  believe,  that  any 
person  in  his  family,  hotel,  boarding  house,  or  premises  is  taken  sick  with  small-pox,  cholera,  diph- 
theria, scarlet  fever,  or  any  other  disease  dangerous  to  the  public  health,  he  shall  immediately  give 
notice  thereof  to  the  health  officer,  the  president  or  the  clerk  of  the  Board  of  Health  of  the  town- 
ship, city,  or  village  in  which  he  resides.  Said  notice  shall  state  the  name  of  the  person  sick,  the 
name  of  the  disease,  the  name  of  the  householder,  hotelkeeper,  keeper  of  boarding  house,  or  tenant 


8        DUTIES  OF  HOUSEHOLDER,  PHYSICIAN  AND  BOARD  OF  HEALTH. 

giving  the  no^ce,  and  shall,  by  street  and  number,  or  otherwise,  sufficiently  designate  the  house  in 
which  he  resides  or  the  room  in  which  the  sick  person  may  be;  and  if  he  shall  refuse  or  neglect  im- 
mediately to  give  such  notice  he  shall  forfeit  for  each  such  offense  a  sum  not  exceeding  one  hundred 
dollars*:  Provided,  That  this  penalty  shall  not  be  enforced  if  a  physician  in  attendance  has  given  to 
the  health  officer  or  other  officer  hereinbefore  mentioned  an  immediate  notice  of  said  sick  person, 
and  true  name  of  the  disease,  in  accordance  with  the  requirements  of  this  section.  §1675,  Howell's 
Statutes,  as  amended  by  Act  11,  Laws  of  1883. 

(1735.)  Sec.  44.  Whenever  any  physician  shall  know  that  any  person  whom  he  is  called  to  visit, 
or  who  is  brought  to  him  for  examination,  is  infected  with  small-pox,  cholera,  diphtheria,  scarlet 
fever,  or  any  other  disease  dangerous  to  the  public  health,  he  shall  immediately  give  notice  thereof 
to  the  health  officer,  the  president  or  the  clerk  of  the  hoard  of  health  of  the  township,  city,  or  village 
in  which  the  sick  person  may  be;  and  to  the  householder,  hotel  keeper,  keeper  of  boarding  house,  or 
tenant  within  whose  house  or  rooms  the  sick  person  may  be.  The  notice  to  the  officer  of  the  board 
of  health  shall  state  the  name  of  the  disease,  the  name,  age,  and  sex  of  the  person  sick,  also  the 
name  of  the  physician  giving  the  notice;  and  shall,  by  street  and  number,  or  otherwise,  sufficiently 
designate  the  house  or  room  in  which  said  sick  person  may  be.  And  every  physician  and  person 
acting  as  a  physician,  who  shall  refuse  or  neglect  immediately  to  give  such  notice  shall  forfeit  for 
each  such  offense  a  sum  not  less  than  fifty  nor  more  than  one  hundred  dollars  * :  Provided,  That 
this  penalty  shall  not  be  enforced  against  a  physician  if  another  physician  in  attendance  has  given 
to  the  health  officer,  or  other  officer  hereinbefore  mentioned,  au  immediate  notice  of  said  sick  per- 
son, and  the  true  name  of  the  disease,  in  accordance  with  the  requirements  of  this  section.  1676 
Howell's,  as  amended  by  Act  11,  Laws  of  1883. 

Sec.  50.  For  each  complete  notice  in  writing  to  an  officer  of  the  board  of  health,  in  full  compliance 
with  the  preceding  section,  requiring  from  physicians  or  other  persons  notices  of  diseases  dangerous 
to  the  public  health,  the  physician  who  gave  the  notice  shall  be  entitled,  on  duly  certifying  that 
each  notice  was  correct,  and  when  the  bill  has  been  duly  audited  by  the  board  of  health,  to  receive 
from  the  township,  city  or  village  in  which  the  notice  was  given,  the  sum  of  ten  cents.— Act  11,  Laws 
of  1883. 

24.  Upon  receipt  of  such  notice,  the  health  officer  and  the  local  board  of  health 
has  duties  to  perform  in  taking  measures  to  restrict  the  spread,  of  the  disease, 
which  it  is  a  great  violation  of  public  trust  for  him  or  for  the  board  to  neglect 
or  postpone.  The  law  is  very  plain  as  to  the  nature  and  the  importance  of 
these  duties.     Three  sections  of  the  law  are  as  follows  : 

(1732)  Sec.  41.    When  the   small-pox  or  any  other  disease  dangerous  to   the  public 
fected  places.        health,  is  found  to  exist  in  any  township,  the  Board  of  Health  shall  use  all  possible  care 
to  prevent  the  spreading  of  the  infection,  and  to  give  public  notice  of  infected  places  to 
travelers,  by  such  means  as  in  their  judgment  shall  be  most  effectual  for  the    com- 
mon safety.— (§1673  Howell's  Annotated  Statutes.) 
Board   to   make      (1706)  Sec.  15.    When  any  person  coming  from  abroad  or  residing  in  any  township 
provision  to  within  this  State,  shall  be  infected,  or  shall  lately  before  have  been  infected,  with 

of  eifisease?re        tQe  small-pox,  or  other  sickness  dangerous  to  the  public  health,  the  Board  of  Health  of 
the  township  where  such  person  may  be  shall  make  effectual  provision  in  the  man- 
ner in  which  they  shall  judge  best  for  the   safety  of   the  inhabitants,  by  removing 
At  expense  of      such  sick  or  jnf  ected  person  to  a  separate  house,  if  it  can  be  done  without  danger  to 
jpMich.  Rep.  475!  nis  healtb>  and  by  providing  nurses  and  other  assistance  and  necessaries,  which  shall 

51  Mich.  p.  526.    beat  the  charge  of  the  person  himself,  his  parents,  or  other  person  who  may  be 

58  IVIicb   d  454 

N.  W.  Reporter',    liable  for  his  support,  if  able;  otherwise,  at  the  charge  of   the  county  to  which  he 

Vol.  16,  p.  887. '    belongs.-(§1647  Howell's  Annotated  Statutes.) 

Provision  in  case  (1707.)  Sec.  16.  If  any  such  infected  person  cannot  be  removed  without  danger  to 
infected  persons  hjs  health,  the  Board  of  Health  shall  make  provision  for  him  as  directed  in  the  pre- 
moved.  ceding  section,  in   the  house  in  which  he  may  be,  and  in  such  case  they  may  cause 

the  persons  in  the  neighborhood  to  be  removed,  and  may  take  such  other  measures 
as  they  may  deem  necessary  for  the  safety  of  the  inhabitants.— (§1648  Howell's  An- 
notated Statutes.) 

♦Supervisors  must  prosecute  for  all  such  forfeitures;  township  officers  must  give  notice  to  super- 
visor; prosecuting  attorney  to  conduct  suit  if  requested;  see  8PCtion<»  8439,  8440,  and  8142,  Howell's 
Annotated  Statutes.  Health  officers  or  villages  and  cities  must  notify  prosecuting 
attorney  of  all  violations  of  this  section,— see  §i684,  Howell's  Statutes;  the  prosecuting  attorney 
must  prosecute  for  all  such  forfeitures  incurred  within  his  county,— see  section  8442,  Howell's 
statutes.    Sections  8439  and  8440  are  printed  on  page  2  of  this  circular. 


RESTRICTION  OF  SMALL-POX.— DUTIES  OF  HEALTH  OFFICER.  9 

25.  Duty  of  the  health  officer. — As  so  much  depends  upon  prompt  action  on 
the  appearance  of  the  first  case  of  small-pox,  and  in  order  that  no  time  may 
be  lost,  it  is  the  duty  of  every  board  of  health  to  make  provision  for  prompt 
action  by  its  health  officer,  authorizing  and  directing  him  to  be  prepared  at 
all  times,  as  executive  officer  of  the  board,  to  take  certain  action  without 
waiting  for  a  meeting  of  the  board,  whenever  a  case  of  small-pox  or  other 
disease  dangerous  to  the  public  health  occurs  within  its  jurisdiction.  Some 
of  the  duties  which  the  health  officer  should  perform  are  specified  in  Act  No. 
137,  laws  of  1883,  as  follows: 

AN  ACT  to  specify  certain  duties  of  health  officers  and  provide  for  com- 
pensation therefor,  in  toicnships,  cities  and  villages  where  the  health 

officer  is  not  otherwise  instructed  by  the  local  board  of  health. 

Section  1.  The  People  of  the  State  of  Michigan  enact,  That  whenever  Powers  and  du- 
the  health  officer  of  any  township,  city  or  village  in  this  State  shall  receive  cers^refereace 
reliable  notice  or  shall  otherwise  have  good  reason  to  believe  that  there  is  t0  diseases  dan- 
within  the  township,  city  or  village  of  which  he  is  the  health  officer,  a  case  geroas  to  public 
of  small-pox,  diphtheria,  scarlet  fever,  or  other  communicable  disease  fleaItl1- 
dangerous  to  the  public  health,  it  shall  be  the  duty  of  said  health  officer, 
unless  he  is  or  shall  have  been  instructed  by  the  board  of  health,  of  which 
he  is  an  executive  officer,  to  do  otherwise, — 

Immediately  to  investigate  the  subject,  and  in  behalf  of  the  board  of 
health,  of  which  he  is  an  executive  officer, — 

To  order  the  prompt  and  thorough  isolation  of  those  sick  or  infected 
with  such  disease,  so  long  as  there  is  danger  of  their  communicating  the 
disease  to  other  persons  ;  — 

To  order  the  prompt  vaccination  or  isolation  of  persons  who  have  been 
exposed  to  small -pox  ; — 

To  see  that  no  person  suffers  for  lack  of  nurses  or  other  necessaries 
because  of  isolation  for  the  public  good  ; — 

To  give  public  notice  of  infected  places*  by  placard  on  the  premises,  and 
otherwise  if  necessary ; 

To  promptly  notify  teachers  or  superintendents  of  schools  concerning 
families  in  which  are  contagious  diseases  ; 

To  supervise  funerals  of  persons  dead  from  scarlet  fever,  diphtheria, 
small-pox.  or  other  communicable  disease  which  endangers  the  public 
health  ; — 

To  disinfect  rooms,  clothing,  and  premises,  and  all  articles  likely  to  be 
infected,  before  allowing  their  use  by  persons  other  than  those  in  isolation  ; 
To  keep  the  President  of  his  own  "board  of  health,  and  the  Secretary  of 
the  State  Board  of  Health  constantly  informed  respecting  every  outbreak 
of  a  disease  dangerous  to  the  public  health,  and  of  the  facts  so  far  as  the 
same  shall  come  to  his  knowledge,  respecting  sources  of  danger  of  any 
such  diseased  person  or  infected  article  being  brought  into  or  taken  out  of 
the  township,  city,  or  village  of  which  he  is  the  health  officer. 

Sec  2.    In  the  absence  of  regulations  conflicting  therewith,  made  and  Provisions  to 
published  by  the  local  board  of  health,  and  still  remaining  in  force,  the  reaJuiatioas°of 
provisions  of  section  one  of  this  act  shall  have  the  force  of  regulations  i0Cai  boards  of 
made  and  published  by  the  local  board  of  health ;  and  whoever  shall  vio-  health,  in  certain 
late  the  provisions  of  section  one  of  this  act,  or  the  orders  of  the  health  p^*-    for  ^^ 
officer  made  in  accordance  therewith,  shall  forfeit  for  each  such  offense  a  i^Qa  of  pTOtte- 
sum  not  exceeding  one  hundred  dollars.  ions. 

Sec.  3.    In  the  fulfillment  of  the  requirements  of  this  act,  the  health  compensation  of 
officer,  unless  other  provision  shall  have  been  made  in  accordance  with  health  officer. 
law,  shall  be  entitled  to  receive  from  the  township,  city  or  village  of 
which  he  is  health  officer,  compensation  at  the  rate  of  not  less  than  two 
(2)  dollars  per  day :    Provided,  That  this  section  shall  not  be  construed  to  Proviso. 
conflict  with  any  action  by  the  local  board  of  health,  under  section  six- 
teen hundred  and  ninety-three,  of  the  compiled  laws  of  eighteen  hundred 
and  seventy-one,  as  amended  by  act  number  two  hundred  and  two,  of  the 
laws  of  eighteen  hundred  and  eighty-one. 

♦Required  by  section  1732,  compiled  laws  of  1871  (§1673,  Howell's),  as  follows  :— 
(1732.)  Sec.  41.    When  the  small-pox,  or  any  other  disease  dangerous  to  the  public  Notice  of  in- 
health,  is  found  to  exist  in  any  township,  the  board  of  health  shall  use  all  possible  care  fected  places. 
to  prevent  the  spreading  of  the  infection,  and  to  give  public  notice  of  infected  places 
to  travelers,  by  such  means  as  in  their  judgment  shall  be  most  effectual  for  the  com- 
mon safety.    §1673,  Howell's  Statutes. 


10  VACCINATE  ALL  EXPOSED  OR  LIKELY  TO  BE  EXPOSED. 

26.  Vaccination  of  attendants  and  all  exposed. — The  attendants  on  the  sick 
with  small-pox  and  all  other  persons  who  it  is  feared  have  been  exposed  to 
small-pox  or  varioloid,  should  immediately  be  vaccinated.  If  properly  vac- 
cinated within  a  day  or  two  after  exposure  to  small-pox,  a  person  has  a  good 
chance  to  escape  small-pox  entirely,  and  if  he  should  come  down  with  vario- 
loid or  modified  small-pox  he  will  probably  have  the  disease  in  a  much  milder 
form  than  if  not  recently  vaccinated.  (See  paragraph  5, — Prevention  of 
small-pox. )     Unless  the  eruption  has  already  appeared,  vaccinate. 

27.  Restriction  of  the  infection. — As  the  contagium  of  small-pox  harbors  in 
carpets,  bedding,  clothing,  etc.,  it  is  best  to  prepare  the  room  in  which  one 
sick  with  small -pox  is  to  be  cared  for,  removing  the  carpets,  pictures,  sofas* 
etc.,  the  bedding  and  clothing  not  required  for  actual  use  in  the  room,  and 
any  other  articles  capable  of  harboring  the  infection  and  which  it  would  be 
difficult  to  disinfect  or  not  desirable  to  burn.  Such  removals  of  carpets, 
bedding,  etc.,  should  not  be  attempted  after  they  have  been  exposed  to 
infection,  unless  properly  disinfected  under  the  direction  of  the  health 
officer.     (See  paragraphs  12  and  15,  on  a  preceding  page  of  this  document.) 

28.  Isolation. — Those  sick  with  small-pox  or  suspected  small-pox  should  at. 
once  be  separated  from  all  other  persons  except  the  necessary  attendants  on 
the  sick. 

29.  Care  of  those  exposed  to  small-pox. — All  persons  known  to  have  been 
exposed  to  small-pox  should  at  once  be  vaccinated,  and  should  be,  so  far  as 
possible,  isolated  from  others  until  it  is  known  whether  they  have  contracted 
small-pox.     This  "period  of  incubation  "  is  usually  about  12  or  15  days. 

30.  Notice  of  infected  place.— Placard  on  house.— A  signboard  or  large  card  as 
a  signal  of  danger,  with  the  words  small-pox  printed  on  it  in  large,  plain 
letters  should  at  once  be  displayed  before  a  house,  and  a  large  card  with  the 
words  small-pox  in  large,  plain  letters  should  be  fastened  on  the  door  of  a 
house  in  which  is  a  case  of  small-pox;  and  without  permission  of  the  health 
officer  no  person  should  be  allowed  to  come  to  the  house  or  go  from  it. 

31.  Who  mav  attend  small-pox  patients. — Any  person  who  has  recently  been 
successfully  vaccinated  or  revaccinated,  or  has  recently  had  small-pox  or 
varioloid,  may  attend  on  small-pox  patients  with  comparative  safety  to  him- 
self, and  in  most  cases  with  absolute  safety  so  far  as  relates  to  danger  from 
small-pox.  No  person  who  has  been  vaccinated  or  has  had  varioloid  or  small- 
pox more  than  ten  years  previously  should  rely  upon  such  experience  for 
security  from  small-pox,  if  exposed  by  attendance  on  a  person  sick  with 
small-pox  or  varioloid.     Such  a  person  should  immediately  be  revaccinated. 

"It  is  now  fully  established  that  a  typical  vaccine  scar  is  not  proof  of  the 
immunity  of  the  individual  from  small-pox.  We  have  admitted  to  the  hos- 
pital *  *  *  711  cases  of  small-pox  exhibiting  typical  cicatrices;  of  which 
number  73  proved  fatal."— W.  M.  Welch,  M.  D.,  in  Philadelphia  Health 
Report,  1872. 

There  is  good  statistical  support  for  the  common  theory  that  the  protective 
influence  of  vaccination,  varioloid  and  small-pox  dies  out  in  seven  years. 
This  is  now  known  to  be  absolutely  true  for  many  persons,  but  there  is  no 
one  period  applicable  to  all  persons,  the  fact  being  that  while  vaccination 
affords  at  first  almost  absolute  protection,  its  influence  is  gradually  worn 
out      Its  protective  influence  is  lost  much  sooner  in  some  persons  than  in. 


RESTRICTION  OF  SMALL-POX.— DISINFECTION.  11 

others,  but  experience  has  shown  (as  in  Philadelphia  in  1871-2)  that  many 
children  vaccinated  in  infancy  have  varioloid  before  they  are  seven  years  of 
age,  while  in  some  instances  one  vaccination  or  one  attack  of  small-pox  pro- 
tects the  individual  through  life.  Inasmuch  as  many  persons  are  known  to 
be  susceptible  to  small-pox  or  vaccination  as  often  as  once  in  ten  years,  and 
as  some  are  susceptible  yet  more  frequently,  this  State  Board  of  Health  has 
advised  revaccination  every  five  years,  as  the  most  judicious  measure  for  the 
prevention  of  small-pox. 

DISINFECTION.* 

32.  Disposal  of  infected  material — All  discharges  from  a  small-pox  patient 
should  be  received  into  vessels  containing  a  strong  solution  of  copperas  (sul- 
phate of  iron),  or  the  zinc-solution  mentioned  in  paragraph  34.  In  cities 
where  sewers  are  in  use  the  disinfected  discharges  may  be  thrown  into  the 
water-closet;  in  other  places  they  should  at  once  be  buried  at  least  100  feet 
distant  from  any  well;  they  should  not  by  any  means  be  thrown  into  a  run- 
ning stream  nor  into  a  cess-pool.  All  cloths,  rags,  etc.,  ^ised  about  the 
patient  should  at  once  be  burned,  or  where  that  is  impracticable  should  be 
thrown  into  a  strong  zinc-solution.  If  necessary,  discharges  from  the  patient 
may  be  received  on  old  cloths  which  should  at  once  be  burned  or  disinfected 
and  buried.     All  vessels  should  be  kept  clean  and  disinfected. 

Bedding,  clothing,  etc.,  should  as  soon  as  removed  from  the  patient  be 
burned.  If  it  is  too  valuable  to  be  destroyed,  it  should  at  once  be  disinfected 
by  boiling  in  the  zinc-solution,  by  heating  in  a  specially  prepared  disin- 
fecting chamber  to  a  temperature  of  250°  Fahr.,  or  by  long  exposure  in  a 
close  room  or  box  to  the  fumes  of  burning  sulphur,  as  stated  in  paragraph 
36,  following. 

Cotton,  linen,  flannels,  blankets,  etc.,  should  be  treated  with  the  boiling  hot  zinc-solution,  intro- 
ducing them  piece  by  piece,  securing  thorough  wetting,  and  boiling  for  at  least  half  an  hour. 

Heavy  woolen  clothing,  silks,  furs,  stuffed  bed-covers,  beds,  and  other  articles  which  cannot  be 
treated  with  the  zinc-solution,  should  be  hung  in  the  room  during  fumigation,  pockets  being  turned 
inside  out  and  the  whole  garment  thoroughly  exposed.  Afterward  they  should  be  hung  in  the  open 
air,  beaten  and  shaken.  Pillows,  beds,  stuffed  mattresses,  upholstered  furniture,  etc.,  should  be  cut 
open,  the  contents  spread  out  and  thoroughly  fumigated.  Carpets  are  best  fumigated  on  the  floor, 
but  should  afterward  be  removed  to  the  open  air  and  thoroughly  beaten,  after  which  they  may  well 
be  again  exposed  to  fumes  of  burning  sulphur. 

33.  The  copperas-solution  may  be  prepared  by  dissolving  sulphate  of  iron 
(copperas)  in  water  in  the  proportion  of  one  and  a  half  pounds  of  copperas 
to  a  gallon  of  water.  When  much  is  wanted  it  may  be  prepared  by  hanging 
a  basket  containing  about  sixty  pounds  of  copperas  in  a  barrel  of  water. 

34.  The  zinc-solution  may  be  prepared  by  dissolving  sulphate  of  zinc  and 
common  salt  in  water  in  the  proportion  of  four  ounces  of  zinc-sulphate  and 
two  ounces  of  salt  to  a  gallon  of  water. 

35.  Care  of  rooms,  etc.,  during  sickness. — So  far  as  consistent  with  the  welfare 
of  the  patient,  the  room  throughout  the  sickness  should  t  e  constantly  venti- 
lated and  frequently  aired.  To  confine  the  poison  in  a  close  room  is  to 
retain  its  power  of  infecting  others.  It  is  well  to  provide  for  disinfecting 
the  foul  air  withdrawn  from  the  room,  as  by  an  open  fire-place  where  this  is 

*  These  methods  of  disinfection  are  applicable  in  other  contagious  diseases  such  as  scarlet  fever, 
diphtheria,  etc.  For  the  statement  of  some  of  the  methods  herein  described  the  State  Board  or 
Health  is  indebted  to  a  circular  on  disinfection  (No.  8)  issued  by  the  National  Board  of  Health. 


12      DISINFECTION  OF  ROOMS,  CORPSES,  CLOTHING  AND  CARRIAGES. 

practicable,  or  by  flues  leading  into  furnaces,  or  kept  constantly  fumigated 
in  some  manner.  It  is  well  to  keep  in  the  sick-room  a  vessel  containing  the 
zinc-solution  (mentioned  in  a  preceding  paragraph)  for  the  reception  of 
towels,  sheets,  and  other  articles  of  clothing  which  are  not  to  be  burned  or 
disinfected  in  a  specially  prepared  oven. 

36.  Disinfection  after  death,  recovery,  or  removal. — After  death,  recovery,  or 
removal  there  should  take  place,  under  the  supervision  of  the  health  officer, 
the  most  thorough  and  complete  disinfection  of  the  house  and  the  contents  of 
the  house  in  which  there  has  been  a  case  of  small-pox.  It  is  far  better  for 
the  community  and  cheaper  for  the  board  of  health  to  pay  a  competent  man 
to  see  that  this  is  properly  done  than  to  take  the  risk  of  its  not  being  done 
well.  This  disinfection  should  be  done  with  fumes  of  burning  sulphur. 
For  this  purpose  the  room  to  be  disinfected  must  be  vacated.  Heavy  cloth- 
ing, blankets,  bedding,  and  other  articles  which  cannot  be  treated  with  zinc- 
solution,  should  be  opened  and  spread  out  so  as  to  be  freely  exposed  during 
fumigation.  Close  the  doors  and  all  large  openings  to  the  room  as  tight  as 
possible,  but  do  not  use  paste,  or  in  any  such  way  cover  surfaces  which  need 
to  be  disinfected,  nor  prevent  free  entrance  of  the  fumes  to  all  cracks 
into  which  the  contagium  may  have  entered.  Place  the  sulphur  in  iron  pans 
supported  upon  bricks,  set  ifc  on  fire  by  hot  coals  or  with  the  aid  of  a  spoon- 
ful of  alcohol  and  a  lighted  match,  and  allow  the  rooms  to  remain  closed  for 
several  hours.  For  a  room  about  ten  feet  square,  three  pounds  of  sulphur 
should  be  burned ;  for  a  larger  room  a  proportionally  larger  quantity  should 
be  used,  that  is  at  the  rate  of  three  pounds  of  sulphur  to  each  one  thousand 
cubic  feet  of  air-space. 

37.  Carefully  avoid  breathing  the  fumes  of  the  burning  sulphur. — After  fumi- 
gation for  several  hours,  the  room  should  be  thoroughly  opened  and  aired, 
before  it  is  again  occupied. 

38.  Care  of  the  corpse — The  corpse  should  be  wrapped  in  a  sheet  wet  with  a 
zinc-solution  of  double  the  strength  specified  in  paragraph  10,  preceding,  and 
buried  at  once.  Metallic,  metal-lined,  or  air-tight  coffins  should  be  used 
when  possible,  certainly  when  the  body  is  to  be  transported  for  any  consid- 
erable distance.  In  no  case  should  the  body  be  exposed  to  view  except  in  a 
perfectly  air-tight  coffin,  and  through  glass;  the  coffin  after  its  final  closure 
having  been  exposed  to  fumes  of  burning  sulphur  of  the  strength  specified 
above. 

39.  Disinfection  of  rooms,  clothing,  etc.,  incidentally  exposed  to  infection — Hotel- 
rooms,  stores,*  cars,  boats,  hacks  or  other  inclosures  which  may  have  been 
exposed  to  infection  should  be  carefully  disinfected  by  fumes  of  burning 
sulphur,  as  specified  in  paragraph  36. 

40.  Funerals — No  public  funeral  should  be  held  at  the  house,  and  no  one 
should  go  to  a  public  funeral  from  the  house  where  one  has  died  from  small- 
pox, or  the  inmates  have  been  exposed  to  the  disease.  Should  any  one  from 
an  infected  or  exposed  house  ride  to  a  funeral  or  a  grave  in  a  public  hack, 
the  robes,  cushions,  etc.,' and  the  interior  of  the  hack  should  immediately 
afterwards  be  thoroughly  disinfected  by  exposure  for  several  hours  to  the 
fumes  of  burning  sulphur,  as  described  in  paragraph  36. 

*  Prof.  Richardson,  of  Philadelphia  says:— (Germ  Theory  of  disease,  Trams.  Pfiila.  Social  Sci- 
ence Amiclation,  Penn  Monthly,  Nov.,  1878.)  Some  years  ago  cases  of  small-pox  occurred  in  the 
house  of  a  dealer  in  ready-made  clothing  near  New  York.  The  whole  stock  of  coats,  pantaloons, 
etc.,  numbering  many  hundreds,  had  an  opportunity  to  become  infected  and  should  have  been  care- 
fully disinfected.  They  were,  however,  sold  at  retail,  and  may  have  given  rise  to  many  cases  of 
"idiopathic"  small-pox  which  no  one  could  trace  to  any  source  of  contagion. 


CONVALESCENTS,  HOSPITALS,  NURSES,  REMOVALS.  13 

41.  Care  of  convalescents — After  recovery  the  patient  should  not  be  allowed 
to  go  abroad  or  to  receive  visitors  until  his  clothing,  etc.,  has  been  carefully 
disinfected  under  the  supervision  of  the  health  officer,  and  until  he  has 
received  from  the  health  officer  or  from  some  competent  physician  a  properly 
authenticated  statement  which  is  approved  by  the  health  officer  that  there  is 
no  longer  any  danger  of  his  communicating  the  disease. 

42.  Hospitals  for  persons  sick  with  diseases  dangerous  to  the  public  health — As 
a  means  of  preventing  the  spread  of  disease,  the  law  authorizes  the  inhab- 
itants of  townships,  cities,  and  villages  to  be  constantly  provided  with  hos- 
pitals for  the  reception  of  persons  having  small-pox,  or  any  other  disease 
dangerous  to  the  public  health;  and  directs  local  boards  of  health  on  the 
outbreak  of  any  such  disease  to  provide  such  hospitals  or  places  of  reception 
for  the  sick  and  infected  as  they  shall  judge  best  for  their  accommodation 
and  the  safety  of  the  inhabitants,  and  to  cause  such  sick  or  infected  persons, 
if  their  condition  will  admit,  to  be  removed  to  such  hospitals  or  places  of 
reception, — said  hospitals,  and  (in  case  the  sick  cannot  be  removed  to  the 
hospital  without  danger  to  life  or  health)  the  houses  where  the  sick  may 
remain,  and  all  persons  connected  with  said  hospitals  or  abodes  of  the  sick 
to  be  subject  to  the  regulations  of  the  board  of  health,  or  of  a  committee 
appointed  by  the  board  of  health  for  that  purpose.  Sections  1726-1733  of 
the  Compiled  Laws  of  1871,  (§1667-1674,  Howell's  Statutes)  relating  to  this 
subject,  and  by  amended  section  1740  *  (  §1681  Howell's  Statutes),  (being 
Sees.  35-42,  and  49  of  chapter  XLVI.)  made  equally  applicable  to  cities, 
villages,  and  townships,  are  as  follows : 

(1726.)  Sec.  35.  The  inhabitants  of  any  township  may  establish  within  their  town-  Hospitals  for 
ship  and  be  constantly  provided  with  one  or  more  hospitals  for  the  reception  of  gonsVaving  P6r" 
persons  having  the  small-pox,  or  other  disease  which  may  be  dangerous  to  the  small-pox,  etc. 
public  health.— §  1667,  HowelVs  Statutes. 

(1727.)  Sec.  36.  All  such  hospitals  shall  be  subject  to  the  orders  and  regulations  of  By  whom  hospi- 
the  board  of  health,  or  a  committee  appointed  by  such  board  for  that  purpose  ;  but  lated  etc_    ™" 
no  such  hospital  shall  be  established  within  one  hundred  rods  of  any  inhabited 
dwelling-house   situated  in  an  adjoining  township,   without  the  consent  of  such 
adjoining  township.— §  1668,  HowelVs  Statutes. 

(1728)  Sec.  37.  If  any  person  shall  inoculate  any  other  person,  or  inoculate  him-  Penalty    for  in- 
self,  or  suffer  himself  to  be  inoculated  with  the  small-pox,  unless  at  some  hospi-  sman-pox.  ex- 
tal  licensed  and  authorized  by  law,  he  shall  for  each  offense,  forfeit  a  sum  not  cept  at  hospitals, 
exceeding  two  hundred  dollars.— §  1669,  HowelVs  Statutes. 

(1729.)  Sec.  38.  When  any  hospital  shall  be  so  established,  the  physician  attend-  Physicians,  etc., 
ing  the  same,  the  persons  inoculated  or  sick  therein,"  the  nurses,  attendants,  and  regulations  of 
all  persons  who  shall  approach  or  come  within  the  limits  of  the  same,  and  all  such  board,  etc. 
furniture  and  other  articles  as  shall  be  used  or  brought  there  shall  be  subject  to 
such  regulations  as  shall  be  made  by  the  board  of  health,    or   of  the  committee 
appointed  for  that  purpose.— §  1670,  HowelVs  Statutes. 

(1730.)  Sec.  39.  When  the  small-pox  or  any  other  disease  dangerous  to  the  public  when  board  of 

health  shall  break  out  in  anv  township,  the  board  of  health  shall  immediately  pro-  health  to  provide 

hospital, 
vide  such  hospital,  or  place  of  reception   for  the  sick  and  infected,  as  they  shall 

judge  best  for  their  accommodation  and  the  safety  of  the  inhabitants;  and  such 

hospitals  and  places  of  reception  shall  be  subject  to  the  regulations  of  the  board  of 

health,  in  the  same  manner  as  herein  [provided  for  established  hospitals.— §  1671 

HowelVs  Statutes. 

(1733.)  Sec.  42.    If  any  physician  or  other  person  in  any  of  the  hospitals  or  places  Penalty  for  vic- 

of  reception  before  mentioned,  or  who  shall  attend,  approach,  or  be  concerned  with  t^onD/0/hosp1- 

the  same,  shall  violate  any  of  the  regulations  lawfully  made  in  relation  thereto,  tals. 

either  with  respect  to  himself,  or  his  or  any  other  person's  property,  the  person  so 

offending  shall,  for  each  offense,  forfeit  a  sum  not  less  than  ten  nor  more  than  one 

hurdred  dollars.    §1674,  Howell's  Statutes. 

*  Printed  on  page  19  of  this  article. 


14  HOSPITAL  CONSTKUCTION,  REMOVALS,  NURSES,  SUPPLIES. 

43.  Hospital  construction,  ventilation,  warming,  etc — In  the  construction  and 
management  oi  hospitals  great  care  should  be  had  for  the  comfort,  safety, 
and  health  of  those  confined  in  or  connected  with  them,  as  well  as  for  the 
safety  of  the  public. 

The  proper  size  and  plan  for  such  a  hospital  may  vary  somewhat  for  differ- 
ent localities;  but  a  few  general  principles  which  should  be  considered  may 
be  mentioned  here.  Particular  attention  should  be  paid  to  ventilatiou.  The 
foul  air  should  be  drawn  off  through  an  opening  or  openings  in  the  floor  or 
in  the  wall  at  the  floor-level,  into  a  heated  flue  open  at  the  top.  In  cold 
weather  the  fresh  air  should  be  warmed  before  it  enters,  or  as  it  enters  the 
room.  This  may  be  done  by  a  furnace  or  by  steam  coils  in  fresh  air  ducts. 
If  stoves  are  used  this  can  be  done  by  jacketing  the  stove  and  providing  an 
inlet  pipe  for  fresh  air  from  out  door  to  the  back  of  the  stove  within  sheet- 
iron  jacket,  as  described  on  pages  55-62  of  the  Eeport  of  the  State  Board  of 
Health  for  1879,  and  on  pages  263-6  of  the  Eeport  for  1880. 

44.  Removal  of  sick  or  infected  persons. — The  law  provides  that  the  board  of 
health  "shall  make  effectual  provision  in  the  manner  in  which  they  shall 
judge  best  for  the  safety  of  the  inhabitants,"  sections  1706,  1731,  and  1707, 
compiled  laws  of  1871  (§§1647,  1672,  and  1648,  Howell's  Statutes),  being  as 
follows: — 

Board  to  make  (1706.)  Sec.  15.  When  any  person  coming  from  abroad  or  residing  in  any  township 
provision  to  pre-  within  this  State  shall  he  infected,  or  shall  lately  before  have  been  infected,  with  the 
small-Dox8  etc  small-pox,  or  other  sickness  dangerous  to  the  public  health,  the  board  of  health  of 
the  township  where  such  person  may  be  shall  make  effectual  provision  in  the  man- 
ner in  which  they  shall  judge  best  for  the  safety  of  the  inhabitants,  by  removing 
such  sick  or  infected  person  to  a  separate  house,  if  it  can  be  done  without  danger  to 
his   health,  and  by  providing  nurses  and  other  assistance  and  necessaries,  which 

3  Mich.  Rep.  475  shall  be  at  the  charge  of  the  person  himself,  his  parents,  or  other  person  who  may  be 

51  Mich   d  526 

58  Mich'  p  454     li3^6  f°r  ms  support,  if  able;  otherwise,  at  the  charge  of  the  county  to  which  he 

belongs.    §  1647,  Howell's  Statutes. 
"When  infected       (1731.)  Sec.  40.  The  board  of  health  shall  cause  such  sick  or  infected  persons  to  be 
persons  to  be  re-  removed  to  such  hospitals  or  places  of  reception,  unless  the  condition  of  the  sick 
™°Tgtc  °    08p  "  person  be  such  as  not  to  admit  of  removal  without  danger  to  life;  in  which  case  the 
house  or  place  where  the  sick  shall  remain  shall  be  considered  as  a  hospital  to  every 
purpose  before  mentioned,  and  all  persons  residing  in  or  in  any  way  concerned  with 
the  same,  shall  be  subject  to  the  regulations  of  the  board  of  health,  as  before  pro- 
vided.   §  1672,  Howell's  Statutes. 
Provision  in  (1707.)  Sec.  16.  If  any  such  infected  person  cannot  be  removed  without  danger  to 

case  infected      his  health,  the  board  of  health  shall  make  provision  for  him  as  directed  in  the  pre- 

persons  cannot        ,,  ..       -,     ,,     .  .  ... 

be  removed.        ceding  section,  m  the  house  in  which  he  may  be,  and  in  such  case  they  may  cause  the 

persons  in  the  neighborhood  to  be  removed,  and  may  take  such  other  measures  as 

they  may  deem  necessary  for  the  safety  of  the  inhabitants.    §  1618,  Howell's. 

45.  Nurses  and  necessary  supplies — Persons  thus  restrained  at  hospital  or  at 
home  should  be  permitted  to  provide  themselves,  or  the  local  board  of  health 
should  provide  them  with  the  best  nursing  and  medical  care.  The  duty  of 
the  board  of  health  is  not  primarily  to  assume  the  care  and  medical  treatment 
of  the  person  sick  with  small-pox  or  other  .disease  dangerous  to  the  public 
health,  but  to  place  that  care  and  treatment  under  such  regulations  as  will 
protect  the  community  from  the  spread  of  the  disease;  but  persons  thus 
restrained  for  the  public  good  are  generally  prevented  from  earning  their 
own  support,  and  the  public  in  thus  enforcing  unusual  conditions  is  bound 
to  provide  proper  care  and  medical  treatment,  food,  etc.,  for  those  not  able 
to  provide  for  themselves.  The  board  of  health  is  authorized  and  required 
to  "provide  nurses  and  other  assistance  and  necessaries,"  at  the  charge  of  the 


€ITY  OR  TOWNSHIP  IS  IMMEDIATELY  LIABLE  BUT  THE  CO.  MUST  PAY.   15 

person  sick,  or  of  those  liable  for  his  support,  if  able  (in  which  case  the  per- 
son sick  will  choose  his  own  medical  attendants),  otherwise  at  the  charge  of 
the  county  to  which  he  belongs.  This  is  provided  for  by  sections  1706  and 
1707,  compiled  laws  of  1871,  printed  above.  See  also  Third  Michigan  Report, 
page  475,  in  which  the  supreme  court  in  1855  granted  a  writ  of  mandamus 
to  compel  the  board  of  supervisors  of  Macomb  county  to  pay  a  claim  for  care 
of  an  indigent  person  sick  with  small-pox,  which  claim  had  been  audited  by, 
and  was  for  services  ordered  by,  the  board  of  health  of  the  village  of  Mt.  Clem- 
ens, under  section  1700  (§1647  Howell's  Statutes),  being  section  15,  of  chapter 
XLVI  of  the  revised  statutes  of  1846.  See  also  51st  Michigan,  page  527, 
where  it  is  held  that  the  city  is  immediately  responsible,  and  that  "in  provid- 
ing that  what  is  done  shall  be  at  the  charge  of  the  individual,  it  is  not 
intended  to  exempt  the  public  from  immediate  liability."  See  also  58th  Mich- 
igan, page  454,  where  it  is  held  that  the  board  of  supervisors  must  pass  such 
accounts  and  can  be  compelled  by  mandamus  to  do. so,  that  they  cannot 
refuse  on  the  ground  that  the  patients  were  themselves  able  to  pay  or  that 
sundry  taxpayers  considered  the  charges  exorbitant. 

46.  Houses,  supplies,  nurses,  etc.,  paid  by  the  county  in  certain  cases. — Nurses  and 
attendants  employed  by  the  sheriff  or  other  officer  in  accordance  with  section 
1709  (§1650  Howell's  Statutes),  owners  of  houses,  stores,  lodgings,  or  other 
necessaries  taken  possession  of  by  either  of  said  officers  in  accordance  with 
sections  1709-1712  (§1650-1653  Howell's  Statutes),  and  other  persons 
properly  employed  by  said  officers  to  assist  in  the  duties  enjoined  by  said 
sections,  are  entitled  to  just  compensation,  to  be  paid  by  the  county.  This 
is  provided  by  section  1714  (§1655,  Howell's  Statutes),  as  follows: 

(1714)  Sec.  23.    Whenever  the  sheriff  or  other  officer  shall  take  possession  of  any  Compensation 
houses,  stores,  lodgings,  or  other  necessaries,  or  shall  employ  any  nurse  or  attend-  for  hous|f' 
ants,  as  provided  in  this  chapter,  the  several  parties  interested  shall  be  entitled  to  a  ' 

just  compensation  therefor,  to  be  paid  by  the  county  in  which  such  person  or  prop- 
erty shall  have  been  so  employed  or  taken  possession  of. 

47.  Duties  of  the  local  hoard  of  health — In  view  of  known  means  of  preventing 
and  restricting  small-pox,  it  would  seem  to  be  the  duty  of  the  local  board  of 
health : — 

(I.)  Frequently  to  place  before  the  people  the  importance  of  vaccination, 
and  to  recommend  general  vaccination  of  all  persons  who  have  not  been 
successfully  vaccinated  within  the  preceding  five  years.  The  board  of  health 
is  authorized  by  Act  No.  146  of  the  laws  of  1879,  to  offer  free  vaccination. 
The  law  reads  as  follows: 

Section  1.   The  People  of  the  State  of  Michigan  enact.  That  the  board  of  health  in  Board  of  Health 
each  city,  village  and  township  may,  at  any  time,  direct  its  health  officer  or  health  f^nf/jf  YaCcina- 
physician  to  offer  vaccination  with  bovine  vaccine  virus  to  every  child  not  previously  tion- 
vaccinated,  and  to  all  other  persons  who  have  not  been  vaccinated  within  the  pre- 
ceding five  years,  without  cost  to  the  persons  [person]  vaccinated,  but  at  the  expense 
of  such  city,  village  or  township,  as  the  case  may  be.— §1685,  Howell's  Statutes. 

(II.)  To  enforce  the  law  (sections  1734  and  1735,  compiled  laws  of  1871, 
pages  7-8  of  this  document),  requiring  householders  and  physicians  to  give 
immediate  notice  of  cases  of  small-pox  and  other  diseases  dangerous  to  the 
public  health.  What  it  is  the  duty  of  the  board  of  health  to  require  the 
people  to  do  for  their  own  safety  it  is  the  duty  of  the  people  to  do  without 
compulsion.  The  board  of  health  should  have  as  prompt  notice  of  the  out- 
break of  a  contagious  disease  as  the  fire  department  has  of  the  outbreak  of 
fire,  and  as  hearty  cooperation  of  citizens  for  the  suppression  of  the  disease 


16    LOCAL  ACTION  FOR  PREVENTION .  AND  RESTRICTION  OF  SMALL-POX. 

as  is  given  the  fire  department  for  the  suppression  of  fire.  And  when  the 
hoard  is  informed  it  should  act  as  promptly,  and  continue  to  act  as  faithfully, 
as  is  done  for  the  extinguishing  of  a  fire. 

(III.)  To  secure  complete  isolation  of  those  sick  or  infected  with  small-pox. 

(IV.)  To  give  the  public  prompt  and  full  notice  of  infected  places  (section 
1732,  compiled  laws  of  1871,  printed  below). 

(V.)  In  general,  and  in  compliance  with  the  following  section  of  law,  to  do 
all  that  may  be  done  by  prompt  and  intelligent  action  to  prevent  the  spread 
of  disease. 

Notice  of  in-  (1732)  Sec.  41.   When  the  small-pox,  or  any  other  disease  dangerous  to  the  public 

fected  places.        health,  is  found  to  exist  in  any  township  [city  or  village*]  the  board  of  health  shall  use 

all  possible  care  to  prevent  the  spreading  of  the  infection,  and  to  give  public  notice  of 

infected  places  to  travelers,  hy  such  means  as  in  their  judgment  shall  be  most 

effectual  for  the  common  safety.— §1673,  Howell's  Statutes. 

(VI.)  To  secure  and  superintend  the  immediate  and  thorough  disinfection 
of  infected  houses,  material,  etc.,  as  directed  in  paragraphs  8-15,  of  this 
document. 

(VII.)  Promptly  to  notify,  by  its  clerk  or  health  officer,  the  State  Board 
of  Health  upon  the  first  outbreak  of  small-pox,  or  any  other  disease  danger- 
ous to  the  public  health,  in  accordance  with  published  requirements  of  the 
State  Board  of  Health  under  section  8  of  act  No.  81,  laws  of  1873. 

48.  The  local  board  of  health  should  make  and  publish  regulations  to  prevent  the 
introduction  of  disease  into  or  its  spread  within  its  locality. 

Kespecting  ar-  (1695.)  Sec.  4.  The  said  board  shall  also  make  such  regulations  as  they  may  deem 
tides  capable  of  necessary  for  the  public  health  and  safety,  respecting  any  articles  which  are  capable 
gion  6etc.  0I  containing  or  conveying  any  infection  or  contagion,  or  of  creating  any  sickDess, 

when  such  articles  shall  be  brought  into,  or  conveyed  from,  their  township,  or  into 
or  from  any  vessel;  and  if  any  person  shall  violate  any  such  regulation,  he  shall  for- 
feit a  sum  not  exceeding  one  hundred  dollars. — §1636,  Howell's  Statutes. 

The  foregoing  section  of  law  is  a  very  important  one ;  but  it  is  useful  only 
after  action  has  been  taken  by  the  local  board  of  health ;  therefore,  every 
board  of  health  should  make  and  publish  and  constantly  maintain  regula- 
tions to  prevent  the  introduction  or  movement  of  articles  capable  of  "  con- 
veying infection  or  contagion"     Such  regulations  should  relate  to : 

(1.)  Persons  sick  with  a  communicable  disease.  (2.)  Bodies  of  persons 
dead  of  a  communicable  disease.  (3.)  Persons  who  have  been  with  the  dead 
or  living  bodies  infected  with  a  communicable  disease,  or  in  a  room  or  place 
occupied  by  such  a  body.  (4.)  Baggage,  clothing,  food,  drink,  or  other 
articles  capable  of  conveying  a  communicable  disease. 

Such  regulations  may  be  in  some  such  form  as  follows : 

Regulations  Relative  to  infectious  Persons  or  Substances. 

No  person  sick  with  cholera,  small-pox,  diphtheria,  scarlet  fever,  or  any  other  dan- 
gerous communicable  disease ;  no  corpse  of  a  person  dead  from  one  of  the  above  named 
diseases;  or  from  any  other  dangerous  communicable  disease;  and  no  article  which  has 
been  infected  or  is  liable  to  propagate  or  convey  any  such  disease,  shall  be  brought  into 
or  removed  within  this  [township,  city  or  village,  as  the  case  may  be,]  without  the 
special  permit  and  direction  of  the  board  of  health  thereof. 

The  foregoing  regulations  shall  remain  in  force  until  revoked  by  the  board  of  health 
of  this  [township,  city  or  village.] 

Whoever  violates  the  foregoing  regulations  incurs  the  penalty  of  the  law. 

♦This  section  is  made  to  apply  to  cities  and  villages  by  section  1740,  compiled  laws  of  1871,  as 
amended  by  act  No.  145,  laws  of  1879  (§1681,  Howell's  Statutes),  printed  on  page  19  of  this  document. 


REGULATIONS.     INSPECTION  OF  TRAVELERS.     PERMITS.  17 

Permits  for  the  removal  of  infected  persons  or  articles,  in  accordance  with  law,  may 
be  granted  by  this  board,  and  by  its  health  officer  when  the  board  is  not  in  session, 
under  circumstances  and  conditions  as  recommended  by  the  State  Board  of  Health. 
Signed, 

j  Members  of  the  Board  of 
j  Health  of  the  [township, 
J      city,  or  village]  of 


Regulations  should  also  be  made  and  published  relative  to  the  restriction 
of  communicable  diseases  at  hospitals  or  houses  where  they  may  be.  Sec- 
tions 1667  to  1674,  Howell's  statutes,  relate  to  this  subject;  some  of  them 
are  printed  on  pages  13-14. 

49.  Notices  of  regulations  of  local  boards  of  health Though  a  more  general 

notice  than  is  required  by  law  should  always  be  given  of  regulations  made  by 
local  boards  of  health,  the  notice  required  by  section  1698,  compiled  laws  of 
1871  (§  1639,  Howell's  Statutes),  should  never  be"  omitted,  as  on  the  giving  of 
this  notice  might  depend  the  success  of  legal  proceedings  begun  by  the  board 
to  enforce  obedience  to  its  regulations : 

(1698.)  Sec.  7.  Notice  shall  be  given  by  tbe  board  of  health  of  all  regulations  made  Notice   of  regu- 
by  them,  by  publishing  the  same  in  some  newspaper  of  the  township,  if  there  be  one  Iatic}!1^  ?ow 
published  therein,  and  if  not,  then  by  posting  them  up  in  five  public  places  in  such 
township;  and  such  notice  of  said  regulations  shall  be  deemed  legal  notice  to  all  per- 
sons.   §  1639,  Howell's  Statutes. 

Section  1698  applies  also  to  boards  of  health  in  cities  and  villages;  and  in 
general  it  should  be  remembered  that  by  the  amended  section  1740  (§  1681,. 
Howell's  Statutes,)  the  provisions  of  all  sections  in  chapter  46  of  the  compiled 
laws  of  1871,  including  sections  1692-1744  and  the  amendments  thereto^ 
apply  so  far  as  applicable  with  equal  obligation  to  the  inhabitants  and  the 
boards  of  health  in  cities  and  villages,  unless  charter  provisions  conflict. 
(See  Sec.  1740  in  paragraph  56,  page  19  of  this  document. ) 

50.  Inspection  of  travelers,  restraint  of  infected  persons Boards   of  health  of 

townships,  cities  and  villages  near  to  or  bordering  upon  neighboring  States 
are  by  section  1708  (§1649,  Howell's  Statutes)  (made  applicable  to  cities  and 
villages  by  Act  145,  laws  of  1879,  printed  on  page  19  of  this  pamphlet)  author- 
ized to  inspect  travelers,  and  to  restrain  from  travel  within  their  jurisdic- 
tion, except  by  license  from  the  board  of  health,  persons  coming  from 
infected  places  in  other  States.     Section  1 708  is  as  follows : 

(1708)  Sec  17.    The  board  of  health  of  any  township*  near  to  or  bordering  upon  Board  may  re- 
either  of  the  neighboring  States,  may  appoint,  by  writing  under  their  hands,  suitable  comine'from^n. 
persons  to  attend  any  places  by  which  travelers  may  pass  from  infected  places  in  fected  districts. 
other  States;  and  the  persons  so  appointed  may  examine  such  passengers  as  they 
may  suspect  of  bringing  with  them  any  infection  which  may  be  dangerous  to  the 
public  health,  and,  if  need  be,  may  restrain  them  from  traveling  until  licensed 
thereto  by  the  board  of  health  of  the  township  to  which  such  persons  may  come;  and 
any  person  coming  from  such  infected  place,  who  shall,  without  license  as  aforesaid, 
travel  within  this  State,  unless  it  be  to  travel  by  the  most  direct  way  to  the  State 
from  whence  he  came,  after  he  shall  be  cautioned  to  depart  by  the  persons  appointed 
as  aforesaid,  shall  forfeit  a  sum  not  exceeding  one  hundred  dollars.— §1649,  Howell's 
Statutes. 

51.  Permits  for  removal  of  an  infected  article  or  sick  person  may  be  granted 
by  the  board  of  health  in  its  discretion. 

*Made  applicable  to  cities  and  villages  by  Act  145,  laws  of  1879  (§1681,  Howell's  Statutes),  printed  on, 
page  19  of  this  pamphlet. 


18  CONTROL  OF  INFECTED  PERSONS,  BAGGAGE  AND  GOODS. 

Board  may  per-  (1705.)  Sec.  14.  The  board  of  health  may  grant  permits  for  the  removtl  of  any  nui- 
mit  removal  of  sance,  infected  article,  or  sick  person  within  the  limits  of  their  township,  when  they 
infected  articles,  ghaU  think  y.  gafe  aQd  proper  so  to  d.o.— §1646,  Howell's  Statutes. 

52.  Restraint  and  removal  of  infected  persons — In  case  of  travelers  and  other 
persons  infected  with  any  disease  dangerous  to  the  public  health,  the  law 
(section  1706,  compiled  laws  of  187L,  in  paragraph  20,  page  7,  of  this  docu- 
ment) requires  the  local  board  of  health  to  make  effectual  provision  for  the 
safety  of  the  inhabitants, — including  removal  of  the  sick  person  to  another 
house  when  this  is  best  and  can  be  done  without  danger  to  the  health  of  the 
person  sick,  otherwise  at  the  house  where  he  may  be. 

In  removing  and  caring  for  any  person  infected  with  contagious  sickness 
the  board  of  health  may  make  use  of  the  sheriff  or  any  constable  of  the 
county,  by  procuring  a  warrant  signed  by  any  two  justices  of  the  peace. 
Section  1709  permits  this,  and  is  as  follows: 

Removal  of  per-  (1709.)  Sec.  18.  Any  two  justices  of  the  peace  may,  if  need  be,  make  out  a  warrant 
sons  infected.  under  their  hands,  directed  to  the  sheriff  or  any  constable  of  the  county,  requiring 
him,  under  the  direction  of  the  board  of  health,  to  remove  any  person  infected  with 
contagious  sickness,  or  to  take  possession  of  convenient  houses  and  lodgings,  and  to 
provide  nurses,  attendants,  and  other  necessaries  for  the  accommodation,  safety, 
and  relief  of  the  sick.— §1650,  Howell's  Statutes. 

53.  Control  of  infected  baggage,  clothing,  goods,  etc — By  sections  1710-1713  the 
board  of  health  is  authorized  to  procure  the  detention,  examination,  and 
purification  at  the  owner's  expense  of  any  baggage,  clothing  or  goods  of  any 
kind,  found  within  the  township,  city  or  village,  which  there  is  just,  cause  to 
suspect  to  be  infected  with  any  disease  dangerous  to  the  public  health.  These 
sections  are  as  follows : 

Infected  bag-  (1710.)  Sec.  19.    Whenever,  on  application  of  the  board  of  health,  it  shall  be  made  to 

fa  d6'     ri if"      appear  to  any  justice  of  the  peace  that  there  is  just  cause  to  suspect  that  any  bag- 
secured.    *  gage,  clothing  or  goods  of  any  kind  found  within  the  township  are  infected  with  any 
disease  which  may  be  dangerous  to  the  public  health,  such  justice  of  the  peace  shall, 
by  warrant  under  his  hand,  directed  to  the  sheriff  or  any  constable  of  the  county, 
require  him  to  take  with  him  as  many  men  as  the  said  justice  shall  deem  necessary 
to  secure  such  baggage,  clothing,  or  other  goods,  and  to  post  said  men  as  a  guard  over 
the  house  or  place  where  such  baggage,  clothing,  or  other  goods  shall  be  lodged, 
which  guard  shall  take  effectual  care  to  prevent  any  person  removing  or  coming 
near  to  such  baggage,  clothing,  or  other  goods,  until  due  inquiry  be  made  into  the 
circumstances  thereof.— §1651,  Howell's  Statutes. 
Impressing  (1711.)  Sec.  20.    The  said  justice  may  also,  by  the  same  warrant,  if  it  shall  appear 
houses,  etc.,  for    to  him  necessary,  require  the  said  officer,  under  the  direction  of  the  board  of  health, 
goods116  lnfected  to  impress  and  take  up  convenient  houses  or  stores  for  the  safe  keeping  of  such  bag- 
gage, clothing,  or  other  goods;    and  the  board  of  health  may  cause  them  to  be 
removed  to  such  houses  or  stores,  or  to  be  otherwise  detained,  until  they  shall,  in  the 
opinion  of  said  board  of  health,  be  freed  from  infection.— §1652,  Howell's  Statutes. 

,    „  (1712)  Sec.  21.    Such  officer  in  the  execution  of  such  warrant,  shall,  if  n-ed  be, 

Power  of  officer  • 

executing  war-     break  open  any  house,  shop,  or  any  other  place  mentioned  in  said  warrant,  where 

rant.  such  baggage,  clothing,  or  other  goods  shall  be;  and  he  may  require  such  aid  as 

shall  be  necessary  to  effect  the  execution  of  the  warrant ;  and  all  persons  shall,  at 

the  command  of  any  such  officer,  under  a  penalty  not  exceeding  ten  dollars,  assist 

in  the  execution- of  the  warrant,  if  able  to  do  so.    §  1653  Howell's  Statutes. 

Charges  to  be         (1713.)  Sec.  22   The  charges  of  securing  such  baggage,  clothing  or  other  goods,  and 

paid  by  owner.      of  transporting  and  purifying  the  same,  shall  be  paid  by  the  owners  thereof,  at  such 

rates  and  prices  as  shall  he  determined  by  the  board  of  health.    §  1654,   Howell's 

Statutes. 

54.  Small-pox  in  a  jail. — The  board  of  health  may  by  written  order  secure 
the  removal  from  a  common  jail  to  a  hospital  or  other  place  of  safety  of  a 
prisoner  attacked  with  a  disease  dangerous  to  tne  safety  and  health  of  the 
other  prisoners  or  of  the  inhabitants  of  the  township,  city  or  village.     Sec- 


SMALL-POX  IN  JAILS  AND  POORHOUSES.  19 

tions  1715  and  1716  authorizing  and  prescribing  the  manner  of  such  removal 
are  as  follows: 

(1715.)  Sec.  24.  Whenever  any  person  confined  in  any  common  jail  shall  be  attacked  When  prisoners 
-with  any  disease,  which,  in  the  opinion  of  the  physician  of  the  board  of  health,  or  *ttacked  ^^ 
of  such  other  physicians  as  they  may  consult,  shall  be  considered  dangerous  to  the  eaBe  may  be  re- 
safety  and  health  of  the  other  prisoners,  or  of  the  inhabitants  of  the  township,  the  moved, 
board  of  health  shall,  by  their  order  in  writing,  direct  the  removal  of  such  person 
to  some  hospital  or  other  place  of  safety,  there  to  be  provided  for  and  securely  kept, 
so  as  to  prevent  his  escape,  until  their  further  orders ;  and  if  such  prisoner  shall 
recover  from  the  disease,  he  shall  be  returned  to  such  jail.    §  1656,  Howell's  Statutes. 

(1716.)  Sec.  25.  If  ths  person  so  removed  shall  have  been  committed  by  order  of  Prisoners  re- 
any  court,  or  under  any  judicial  process,  the  order  for  his  removal,  or  a  copy  thereof,  j^g^  ^ndaol 
attested  by  the  presiding  member  of  said  board  of  health,  shall  be  returned  by  him,  to  be  considered 
with  the  doings  thereon,  into  the  office  of  the   clerk  of  the  circuit  court  for  the  as  having 
county;  and  no  prisoner,  removed  as  aforesaid,  shall  be  considerod  as  thereby  hav-  escaPed- 
ing  committed  an  escape.    §  1657,  Howell's  Statutes.     - 

55    Small-pox  in  a  poorhouse — On  the  outbreak  in  a  county  poorhouse  or  in 

the  vicinity  thereof  of  any  pestilence  or  contagious  disease  likely  to  endanger 
the  health  of  persons  supported  at  the  poorhouse,  the  superintendents  are  by 
section  1717  required  to  remove  to  some  other  suitable  place  any  or  all  of  the 
persons  there  supported  until  they  can  safely  be  returned  or  otherwise  be 
discharged.     Section  1717  is  as  follows: 

(1717.)  Sec.  26.  Whenever  any  pestilence  or  contagious  disease  shall  break  out  in  When  superin- 
any  county  poorhouse  in  this  State,  or  in  the  vicinity  thereof,  and  the  physician  to  indents  of  poor 
such  county  poorhouse,  or  such  other  physician  as  the  superintendents  may  consult,  p^p^rTfrom 
shall  certify  that  such  pestilence  or  disease  is  likely  to  endanger  the  health  of  the  poorhouses. 
persons  supported  at  such  poorhouse,  the  superintendents  of  such  county  poorhouse 
shall  cause  the  persons  there  supported,  or  any  of  them,  to  be  removed  to  some  other 
suitable  place  in  the  same  county,  there  to  be  maintained  and  provided  for  at  the 
expense  of  the  county,  with  all  necessary  medical  attendance  and  care,  until  they 
can  safely  be  returned  to  such  poorhouse,  or  otherwise  discharged.    §  1653  Howell's 
Statutes. 

56.  Boards  of  Health  in  cities  and  villages.    Certain  Laws  *relative  to 
townships  are  made  applicable  to  cities  and  villages  :— 

Section  1710,  as   amended  by  Act  No.  145,  laws  of  1879    (§1681,  Howell's 
Statutes)  is  as  follows: 

(1740.)  Sec.  49.    The  mayor  and  aldermen  of  each  incorporated  city,  and  the  presi-  Board  of  Health 

dent  and  council,  or  trustees  of  each  incorporated  village  in  this  State,  in  which  no  jn  ci:ie8  and  Tii- 

lages.  wn  >  to 
board  of  health  is  organized  under  its  charter,  shall  have  and  exercise  all  the  powers  constitute. 

and  perform  all  the  duties  of  a  board  of  health  as  provided  in  this  chapter,  within 
the  limits  of  the  cities  or  villages,  respectively,  of  which  they  are  such  officers.    The 
provisions  of  this  chapter  [*]  and  the  amendments  thereto,  shall,  as  far  as  applicable, 
apply  to  all  cities  and  villages  in  this  State,  and  all  duties  which  are,  by  the  pro- 
visions of  this  chapter  [_*]  to  be  performed  by  the  board  of  health'of  townships,  or  by  Duties  of  officers 
the  officers  and  inhabitants  thereof,  shall  in  like  manner  be  performed  by  the  board  a?  :)?    and"113 
of  health  and  the  officers  and  inhabitants  of  such  cities  and  villages,  with  a  like  villages, 
penalty  for  the  non-performance  of  such  duties,  excepting  in  cases  where  the  charters 
of  such  cities  and  villages  contain  provisions  inconsistent  herewith. 


*Chapter  46  of  the  Compiled  Laws  of  1871. 


In  July,  1877,  the  Michigan  State  Board  of  Health  passed  a  resolution  advising  and  requesting  all 
boards  of  health  to  offer  every  year  free  vaccination  with  bovine  virus  to  every  child  not  previously 
vaccinated  and  to  all  other  persons  not  vaccinated  within  five  years.  The  resolution  was  then,  and 
has  since  been  widely  distributed  throughout  the  State.  Act  146,  Laws  of  1879  embodied  this  recom- 
mendation in  law. 

October  23,  1838,  the  State  Board,  by  resolution,  requested  the  boards  of  health  of  all  the  cities,  vil- 


20  PREVENTION  AND  RESTRICTION  OF  SMALL-POX. 

lages,  and  townships  in  Michigan  "to  recommend  the  vaccination  of  all  unprotected  persons  within 
their  jurisdictions."    A  circular  to  this  effect  was  sent  to  every  health  officer  in  Michigan. 

This  tract  is  a  revised  edition  of  the  document  issued  hy  this  Board  in  1882.  It  more  fully  sets 
forth  the  importance  of  vaccination,  and  other  means  for  the  prevention  and  restriction  of  small- 
pox. 

It  is  hoped  that  local  hoards  of  health,  newspapers,  and  all  public-spirited  persons  will  aid  in   ] 
spreading  the  information  herein  contained.  <* 

/-  Since  the  State  Board  of  Health  was  established,  many  thousands  of  people  in  Michigan  have  been 
vaccinated  because  of  its  recommendations;  and  the  statistics  of  deaths,  published  by  the  Secretary 
of  State,  show  that  at  the  close  of  the  year  1884  the  death-rate  from  small-pox  in  Michigan  had  been 
so  much  less  than  before  the  Board  was  established  as  to  indicate  that  over  one  thousand  lives  had 
then  been  saved  from  that  loathsome  disease.  We  have  now  (at  the  close  of  1888)  added  to  that 
record  four  more  years  of  comparative  freedom  from  small-pox,  which  means  a  further  saving  of 
human  life,  due,  it  is  believed,  to  the  preventive  measures— vaccination  and  revaccination,  and  the 
increased  efficiency  of  local  boards  of  health  in  restricting  the  disease. 

A  copy  of  this  document  may  be  obtained  by  any  person  in  Michigan  by  addressing  the  Secretary 
of  the  State  Board  of  Health,  Lansing,  Michigan. 


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